Project Change Request Template



|Project Name | |Change Number | |

|Requested By | |Date of Request | |

|Presented To | | | |

|Change Name | |

|Description of Change: |

| |

|Reason for Change: |

| |

|Effect on Deliverables (including a list of any affected deliverables): |

| |

|Effect on Organization: |

| |

|Effect on Schedule (including Estimated Completion Date for this change): |

| |

|Effect on Project Cost: |

|Item Description |Hours |Dollars |

| |Reduction |Increase |Reduction |Increase |

|Analysis | |0 | |$ 0.00 |

|Development (Code and Unit Test) | |0 | |$ 0.00 |

| | | | | |

|Total Net Change in Cost: | |$ 0.00 |

|Effect of NOT Approving this Change: |

| |

|Reason for Rejection (if applicable): |

| |

|Functional Project Manager |

| Approved |Signature: | |

| Rejected |Title: | |Date: | |

| |

|USF IT |

| Approved |Signature: | |

| Rejected |Title: | |Date: | |

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